Windisch Gunther, Anderhuber Friedrich, Haldi-Brändle Verena, Exner Gerhard Ulrich
Institute of Anatomy, Medical University Graz, Harrachgasse 21, 8010, Graz, Austria,
J Child Orthop. 2007 Mar;1(1):79-85. doi: 10.1007/s11832-006-0004-2. Epub 2007 Jan 4.
The aim of our study was to evaluate the pathological anatomy of the ligaments, tendons and muscles in clubfeet, and to show whether the dysbalance of shortened and elongated structures is an adaptive process or a primary factor inducing the misshaped bones and cartilagines.
Surgical exposure was performed on seven idiopathic clubfeet specimens, aborted between the 25th and 37th week of gestation and compared to two normal feet (27th and 36th week of gestation).
The medial stabilisation system of the foot was found shortened, but all ligaments could be dissected. On the lateral side, the calcaneofibular ligament in particular was both 'shortened' and 'elongated', depending on the course of the fibres to the axis of motion in the subtalar and talocalcaneonavicular joint. The main difference to the normal feet was found in the thickened tendon of the tibialis posterior forming a bulbus before dividing into fascicules.
We presume the ossification disturbance of the calcaneus to be the primary fault. This disturbance will influence the reduction of the varus position, so ligaments and tendons will be conformed to the misshaped bones.
我们研究的目的是评估畸形足中韧带、肌腱和肌肉的病理解剖结构，并探讨缩短和拉长结构的失衡是一种适应性过程还是导致骨骼和软骨畸形的主要因素。
对7例特发性畸形足标本进行手术暴露，这些标本取自妊娠25至37周期间流产的胎儿，并与2例正常足（妊娠27周和36周）进行比较。
发现足部的内侧稳定系统缩短，但所有韧带均可解剖。在外侧，尤其是跟腓韧带，根据其纤维走向距下关节和距跟舟关节运动轴的方向，既“缩短”又“拉长”。与正常足的主要差异在于，胫后肌腱增厚，在分成束之前形成一个球状物。
我们推测跟骨的骨化障碍是主要缺陷。这种障碍会影响内翻位的矫正，因此韧带和肌腱会顺应畸形的骨骼。
